Hospital takes new approach to repairing aortic aneurysm

San Clemente resident Mary Liz Crook, 77, underwent treatment for a complex abdominal aortic aneurysm in January. Crook's mother died from a burst abdominal aortic aneurysm at the same age. ISAAC ARJONILLA, ORANGE COUNTY REGISTER

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Mary Liz Crook underwent treatment for a complex abdominal aortic aneurysm in January. Crook was the first patient in Southern California to undergo the surgery, which uses a new type of stent. ISAAC ARJONILLA, ORANGE COUNTY REGISTER

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Recovery time for standard surgery to repair complex abdominal aortic aneurysms is five to seven days in the hospital and up to six weeks of recovery at home. That time is cut by two-thirds with the new surgery. ISAAC ARJONILLA, ORANGE COUNTY REGISTER

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Dr. Wang Teng is one of 30 surgeons in the nation trained to use a new stent to treat complex abdominal aortic aneurysms. He is standing in front of a fluoroscopy machine at Saddleback Memorial Medica Center. Teng uses the machine to guide him through the surgical procedure of inserting a stent into the aorta to treat complex abdominal aortic aneurysms. ISAAC ARJONILLA, ORANGE COUNTY REGISTER

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Dr. Wang Teng has been working at Saddleback Memorial Medical Center for the seven years. Teng has five patients being considered for the new surgical approach to treating complex abdominal aortic aneurysms. ISAAC ARJONILLA, ORANGE COUNTY REGISTER

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Dr. Wang Teng holds an intervention sheath and a guide wire. The stent is placed over the guide wire, through the sheath and into the aorta; the fluoroscopy machine is used to guide him through the procedure. ISAAC ARJONILLA, ORANGE COUNTY REGISTER

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With the help of the fluoroscopy machine, Dr. Wang Teng shows an example of what an aortic aneurysm looks like after the procedure has been completed. ISAAC ARJONILLA, ORANGE COUNTY REGISTER

San Clemente resident Mary Liz Crook, 77, underwent treatment for a complex abdominal aortic aneurysm in January. Crook's mother died from a burst abdominal aortic aneurysm at the same age.ISAAC ARJONILLA, ORANGE COUNTY REGISTER

About abdominal aortic aneurysms

•More than 1 million people are living with undiagnosed abdominal aortic aneurysms.

•The disease is more common in men – they are five times to ten times more likely than women to have the aneurysms – and in people ages 60 and older.

•Risk factors include age, a family history of the disease, high blood pressure and obesity.

•Smokers are eight times more likely to be affected than nonsmokers.

•75 percent to 90 percent of patients do not survive a ruptured abdominal aortic aneurysm.

Abdominal aortic aneurysms kill 15,000 people annually. The disease is the 13th leading cause of death in the U.S. and third leading cause of sudden death in men over 60.

Sources: Centers for Disease Control and Prevention; AneurysmOutreach.org

LAGUNA WOODS – Mary Liz Crook was walking around with a time bomb ticking in her belly, and it was scaring her to death.

Six years earlier, Crook, 77, had been diagnosed with a complex abdominal aortic aneurysm, an abnormal ballooning of the wall of the aorta, the main artery supplying blood to the lower part of the body.

Medical professionals call abdominal aortic aneurysms the "silent killer" because of their lack of symptoms. Once the aneurysm ruptures it's almost always lethal. Two out of three people do not survive long enough to get to a hospital.

Crook worried she would suffer the same fate as her mother, who had died from a ruptured aneurysm while in her garden. She, too, was 77.

"She had developed a deep-seated fear of death," her daughter June Crook, 49, said. "She thought if she moved the wrong way, she might die."

To complicate matters, traditional stent graft surgery was not an option for Crook because of the aneurysm's location, adjacent to her kidney arteries.

Location, however, proved to be everything for Crook. In fall she learned she was a candidate for a new minimally invasive procedure to treat complex abdominal aortic aneurysms.

Surgery was scheduled in late January at Saddleback Memorial Medical Center in Laguna Hills. Crook became the first patient in Southern California to be treated using a fenestrated endovascular stent graft.

FOUR-HOUR PROCEDURE

The operation was performed by Dr. Wang Teng, one of 30 vascular surgeons in the nation trained to use the stent, which received FDA approval in April 2012.

"Dr. Teng was chosen because he has the talent to be able to perform the procedure, and we have the technical ability to help him," Saddleback Memorial CEO Steve Geidt said.

Since the first stents were placed last fall, more than 300 have been implanted nationwide, Teng, 41, said. He has five patients being considered for the surgery.

"What's unique about the fenestrated graft is it allows us to treat aneurysms that we couldn't treat with traditional stent grafts," he said. "It allows us to treat a broader range of patients."

The four-hour procedure involves inserting a flexible, fabric-lined stent in the aorta that reinforces its inner lining. The stents are customized to fit patients' anatomy based on 3-D reconstructions of their CT scans. The stent is delivered through a small incision in the groin. Once placed, it is unwrapped and positioned inside the artery.

Teng said most patients require a two-day hospital stay with a two-week recovery period at home. Until now, treatment of complex abdominal aortic aneurysms required open abdominal surgery with a five- to seven-day hospital stay and up to six weeks of recovery time at home.

Many patients are too sick to tolerate open abdominal surgery and must live with the risk of the aneurysm rupturing, Teng said.

GONE FISHING

After a day and a half in the intensive care unit and two days in the hospital's surgical unit, Crook left Saddleback Memorial. She spent a short time at a rehabilitation center because of other health issues before returning home to San Clemente.

Three months post-surgery, Crook said she feels magnificent: "I've had no problems at all – nothing to report, just a little discomfort from the incision. It's been a piece of cake."

"The procedure has given us our mother, and the opportunity to have some quality of time with her, especially after my father's death," June Crook said. "As much as she spent time giving to my family and our father, we wanted for her to have a life for herself. And now she has that chance."

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